Right Atrial Perforation Secondary to Implantable Cardioverter Defibrillator Insertion

Implantable cardioverter defibrillator (ICD) placements can be associated with serious complications. This paper reports a patient in whom percutaneous placement of an ICD resulted in a hemopneumothorax. This was due to an active fixation lead that perforated the right atrial wall and injured the adjacent lung parenchyma. The hemothorax was drained thoracoscopically, and the atrial injury was covered with fibrin glue.

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Minimal Cardiac Perforation by Lead Pacemaker Complicated with Pericardial Effusion and Impending Tamponade: Optimal Management with No Pericardiocentesis Driven by Echocardiography

Diagnostics ◽

10.3390/diagnostics10040191 ◽

2020 ◽

Vol 10 (4) ◽

pp. 191

Author(s):

Carlo Caiati ◽

Paolo Pollice ◽

Luigi Truncellito ◽

Mario Erminio Lepera ◽

Stefano Favale

Keyword(s):

Pericardial Effusion ◽

Right Ventricular ◽

Implantable Cardioverter Defibrillator ◽

Optimal Management ◽

Cardiac Perforation ◽

Cardioverter Defibrillator ◽

Active Fixation ◽

Fixation Screw ◽

The Right ◽

Fluoroscopy Guidance

We report the case of a 51-year-old patient who underwent the implantation of a bi-ventricular implantable cardioverter defibrillator (ICD) complicated by a sub-acute right ventricular minimal perforation with pericardial effusion and echocardiographic signs of tamponade. A new echocardiographic plane orientation allowed us to diagnose this condition in emergency and to make the right decision without delay, which consisting in unscrewing the active fixation screw under fluoroscopy guidance, while the pericardiocentesis was postponed. Thanks to the intervention focused on eliminating the cause of the postcardiac injury syndrome, the patient recovered rapidly and ultimately avoided the pericardiocentesis procedure.

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Relapsed Brucellosis Manifested as Endocarditis with Vegetation on the Implantable Cardioverter Defibrillator Lead

Case Reports in Cardiology ◽

10.1155/2021/9925775 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Bisher Sawaf ◽

Wael Kanjo ◽

Yasir Alabbas ◽

Ahmad Hatim ◽

Unus K. Bedardeen ◽

...

Keyword(s):

Infective Endocarditis ◽

Implantable Cardioverter Defibrillator ◽

Brucella Melitensis ◽

Right Atrial ◽

Surgical Removal ◽

Cardioverter Defibrillator ◽

Defibrillator Lead ◽

Device Extraction ◽

Lead Endocarditis ◽

The Right

Implantable cardioverter defibrillator lead endocarditis due to Brucella melitensis is a rare and life-threatening complication of brucellosis. Successful management requires a combination of medical treatment and device extraction. We present a case of relapsing brucellosis manifested as infective endocarditis colonizing the lead of the implantable cardioverter defibrillator with formation of vegetation on the lead. A 63-year-old male presented to the rehabilitation unit with hypotension. No other signs of infection were noted. The patient had a history of drinking unpasteurized milk since childhood and a previous episode of Brucella infective endocarditis. A transthoracic echocardiography showed an oscillating vegetation on the lead of the tip of the right atrial ICD, and the blood cultures were positive for Brucella melitensis. Surgical removal of the device was infeasible, and medical management was the only feasible option in this case.

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Closure of Secundum Atrial Septal Defect with Autologous Right Atrial Patch: Case Report

The Heart Surgery Forum ◽

10.1532/hsf98.20041173 ◽

2005 ◽

Vol 8 (2) ◽

pp. 96 ◽

Cited By ~ 1

Author(s):

Osman Tansel Dar�in ◽

Alper Sami Kunt ◽

Mehmet Halit Andac

Keyword(s):

Atrial Septal Defect ◽

Right Atrium ◽

Septal Defect ◽

Complete Recovery ◽

Interatrial Septum ◽

Right Atrial ◽

Atrial Wall ◽

Residual Shunt ◽

Asd Closure ◽

The Right

Background: Although various synthetic materials and pericardium have been used for atrial septal defect (ASD) closure, investigators are continuing to search for an ideal material for this procedure. We report and evaluate a case in which autologous right atrial wall tissue was used for ASD closure. Case: In this case, we closed a secundum ASD of a 22-year-old woman who also had right atrial enlargement due to the defect. After establishing standard bicaval cannulation and total cardiopulmonary bypass, we opened the right atrium with an oblique incision in a superior position to a standard incision. After examining the secundum ASD, we created a flap on the inferior rim of the atrial wall. A stay suture was stitched between the tip of the flap and the superior rim of the defect, and suturing was continued in a clockwise direction thereafter. Considering the size and shape of the defect, we incised the inferior attachment of the flap, and suturing was completed. Remnants of the flap on the inferior rim were resected, and the right atrium was closed in a similar fashion. Results: During an echocardiographic examination, neither a residual shunt nor perigraft thrombosis was seen on the interatrial septum. The patient was discharged with complete recovery. Conclusion: Autologous right atrial patch is an ideal material for ASD closure, especially in patients having a large right atrium. A complete coaptation was achieved because of the muscular nature of the right atrial tissue and its thickness, which is a closer match to the atrial septum than other materials.

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Atrial Lipomatous Hypertrophy: Lipomatous Atrial Hypertrophy With Significant Involvement of the Right Atrial Wall

Journal of the American Society of Echocardiography ◽

10.1016/s0894-7317(14)80253-8 ◽

1993 ◽

Vol 6 (1) ◽

pp. 30-34 ◽

Cited By ~ 12

Author(s):

Ira S. Cohen ◽

Krishnakant Raiker

Keyword(s):

Right Atrial ◽

Atrial Wall ◽

Lipomatous Hypertrophy ◽

The Right

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Abstract 15570: Direct Evidence of Endo-Epicardial Dissociation of the Atrial Wall in Patients With Longstanding Persistent Atrial Fibrillation

Circulation ◽

10.1161/circ.132.suppl_3.15570 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Natasja de Groot ◽

Lisette vd Does ◽

Ameeta Yaksh ◽

Paul Knops ◽

Pieter Woestijne ◽

...

Keyword(s):

Atrial Fibrillation ◽

Direct Evidence ◽

Persistent Atrial Fibrillation ◽

Right Atrial ◽

Electrode Arrays ◽

Atrial Wall ◽

Ablative Therapies ◽

Epicardial Layer ◽

Right Atrial Appendage ◽

The Right

Introduction: Transition of paroxysmal to longstanding persistent atrial fibrillation (LsPAF) is associated with progressive longitudinal dissociation in conduction and a higher incidence of focal fibrillation waves. The aim of this study was to provide direct evidence that the substrate of LsPAF consists of an electrical double-layer of dissociated waves, and that focal fibrillation waves are caused by endo-epicardial breakthrough. Hypothesis: LsPAF in humans is caused by electrical dissociation of the endo- and epicardial layer. Methods: Intra-operative mapping of the endo- and epicardial right atrial wall was performed in 9 patients with induced (N=4), paroxysmal (N=1), persistent (N=2) or longstanding-persistent AF (N=2). A clamp of two rectangular electrode-arrays (128 electrodes; inter-electrode distance 2mm) was introduced through an incision in the right atrial appendage. Series of 10 seconds of AF were analyzed and the incidence of endo-epicardial dissociation (≥15ms) was determined for all 128 endo-epicardial recording sites. Results: In patients with LsPAF the averaged degree of endo-epicardial dissociation was highest (24.9% vs. 5.9%). Using strict criteria for breakthrough (presence of an opposite wave within 4mm and <15ms before the origin of the focal wave), the far majority (77%) of all focal fibrillation waves could be attributed to endo-epicardial excitation. Conclusions: During LsPAF considerable differences in activation of the right endo- and epicardial wall exist. Endo-epicardial fibrillation waves that are out of phase, may conduct transmurally and create breakthrough waves in the opposite layer. This may explain the high persistence of AF and the low succes rate of ablative therapies in patients with LsPAF.

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Cardiac tamponade secondary to hemorrhagic pericardial effiision in five dogs

Journal of the Hellenic Veterinary Medical Society ◽

10.12681/jhvms.15064 ◽

2017 ◽

Vol 56 (1) ◽

pp. 9

Author(s):

C. G. HATZIGIANNAKIS (Χ.Γ. ΧΑΤΖΗΓΙΑΝΝΑΚΗΣ) ◽

M. E. MYLONAKIS (Μ. Ε. ΜΥΛΩΝΑΚΗΣ) ◽

M. N. SARIDOMICHELAKIS (Μ.Ν. ΣΑΡΙΔΟΜΙΧΕΛΑΚΗΣ) ◽

M. PATSIKAS (Μ. ΠΑΤΣΙΚΑΣ) ◽

D. PSALLA (Δ. ΨΑΛΛΑ) ◽

...

Keyword(s):

Ultrasound Examination ◽

Histopathological Examination ◽

Clinical Findings ◽

Pericardial Fluid ◽

Exercise Intolerance ◽

Right Atrial ◽

Atrial Wall ◽

History Of ◽

Cardiac Silhouette ◽

The Right

A 7-year old female collie (case 1), a 3-year old male Caucasian-cross (case 2) and three male German shepherds with an age of 11 (case 3), 8.5 (case 4) and 10 (case 5) years, respectively, were admitted with a history of decreased appetite, depression, exercise intolerance, dyspnea and progressive abdominal enlargement, for the last 10 to 60 days. Poor body condition (5/5), muffled heart sounds (5/5), weak femoral pulse (5/5), ascites (5/5), inspiratory or inspiratory-expiratory dyspnea (5/5), pulsus paradoxus (2/5) and jugular vein distension (2/5) were the prominent clinical findings, while mature neutrophilic leukocytosis (3/5), lymphopenia (3/5), eosinopenia (3/5), hypoproteinemia (5/5) and increased urea nitrogen (3/5) were the most prevalent clinicopathologic abnormalities. Apart from a space-occupying lesion onto the right atrial wall of one dog (case 4), radiographic and ultrasound examination showed a globe-shaped cardiac silhouette (5/5), pericardial effusion (5/5), ascites (5/5) and pleural effusion (4/5). A large amount of non-clotting hemorrhagic effusion was drained during pericardiocentesis, resulting in rapid clinical recovery. Physical, chemical and cytological evaluation of the pericardial fluid was non-contributory in the differentiation between neoplastic and non-neoplastic causes of these effusions. Case 3 died 25 days post-pericardiocentesis; right atrium hemangiosarcoma and pulmonary metastases were documented on post mortem histopathological examination. Another dog (case 5) died of unknown causes one month after pericardiocentensis. On the contrary, dogs 1, 2 and 4 were still clinically healthy for a followup period of 16, 2 and 8 months, respectively.

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